The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) was developed to measure a hospital's use of technology for optimized patient care. Globally, the EMRAM has become the gold standard for health IT maturity, and countless organizations have followed the model on their journey toward better patient care, lower costs and improved overall health for populations.

The Challenge

Since its opening in 1899, LVHN has eight campuses, over 250 physician practice locations, 95 medical specialties and over 2,000 physicians. LVHN is a member of Vizient, an organization that features an Academic Medical Center/Teaching Hospitals database, allowing members to benchmark their internal clinical care against leading Medical Centers in the United States.

Over the years, LVHN clinical leadership noticed their mortality rankings slipping in the database. In reviewing the data, both from Vizient comparisons and what was contained in their EMR systems, they were able to attribute this overall slip to increased levels of inpatient sepsis. For these patients, about 90 percent were admitted via the emergency department with sepsis pre-admission, and about 10 percent developed sepsis during inpatient admission.

Although best practices for sepsis care are established, they're challenging to enforce at the right time for all relevant patients. Each patient's condition varies slightly based on their background, and implementing tailored protocols on a case-by-case basis isn't easy.

The EMRAM Implementation

After discovering the challenges contributing to the increased sepsis mortality rates, they brought together a team of 60 cross-functional colleagues to implement a new Sepsis Quality Improvement Project.

LVHN implemented EMR-based algorithms to track all ED and inpatients for clinical signs of pre-sepsis and sepsis. A combination of clinical risk scores and real-time alerts helped clinicians assess and screen patients more quickly and accurately. The team created clinical order sets including labs, antibiotics, IV fluids and other best-practice treatments for sepsis and made them available for immediate use in the case of a sepsis diagnosis. Additionally, the team trained all clinicians on sepsis best practices and offered clinical support for questions and assistance when needed.

LVHN also created a sepsis registry using an advanced data visualization tool in the EMR, to measure compliance with best practices, identify the severity of sepsis and track the illness across all locations. Additionally, they integrated clinical data from the EMR with claims data and found new information that further indicated the need for improvement, including:

18 percent of patients with sepsis had no primary care physician.

32 percent of sepsis episodes resulted in readmission.

30 percent were later treated in a skilled nursing facility.

95 percent of sepsis patients have chronic conditions.

Using this increased visibility into the continuum of care for sepsis patients, LVHN implemented further improvements, including the creation of a real-time EMR-based worklist to link sepsis patients with a primary care physician for ongoing clinical management.

The Results

In the second quarter of 2015, LVHN ranked 117th in the Vizient database for sepsis mortality. Five months after the sepsis project was deployed, their ranking was elevated to 9th place; they were able to decrease inpatient sepsis mortality rates by 40 percent, driving overall mortality rates to historically low levels.

Currently, LVHN is working to implement more advanced, real-time alerts based on predictive analytics models to improve compliance, increase the advanced identification of patients with the potential for sepsis and ultimately, reduce sepsis mortality even further with tracking and alert tools across the continuum of care.

The Takeaway

“We have learned so much more about our patient populations by using the EHR and modern analytical tools," said Dr. Matthew McCambridge, chief quality officer of LVHN, "and we are using these to better manage and assess how we take care of our patients across the entire continuum; to deliver our mission to heal, comfort, and care for the people of our community.”

This project was a significant learning opportunity for LVHN; by incorporating new tools with a fully-integrated EMR and advanced analytics, they discovered new insights and used real-time data to create lasting change. Like LVHN, hospitals around the world can use the EMRAM stages as a guide to continuously innovate and improve diagnosis, treatment and care outcomes for their patients.

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